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Article Dans Une Revue Journal of Vascular Surgery Année : 2018

Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms

Résumé

We report our experience of the treatment of postdissection arch aneurysms and thoracoabdominal aortic aneurysms (TAAAs) by endovascular repair using fenestrated and branched endografts. This study includes all patients presenting with chronic postdissection aneurysms >55 mm in diameter deemed unfit for open surgery and treated by complex endografting between October 2011 and April 2017. Where appropriate, staged management strategies including left subclavian artery revascularization, thoracic endografting, dissection flap fenestration, and tear enlargement were performed before the complex endovascular repair. Outcome data were collected prospectively, specifically including technical success, endoleaks, target vessel patency, aneurysm diameter, adverse events, reinterventions, and mortality. We treated 40 patients with a median age of 63 years (55-71 years). In total, 43 procedures were performed: 19 arch repairs using inner branch endografts (one to three branches) and 24 TAAA repairs using fenestrated or branched endografts. Three patients were treated using both arch and TAAA repair. The median time between initial presentation with acute dissection and the first complex aortic repair was 5 years (3.0-10.0 years). Staged procedures were performed in 33 of 40 patients (82.5%). The technical success rate was 93%, the median procedure length was 240 minutes (170-285 minutes), and the median dose-area product was 80 Gy · cm22 Complex endovascular repair of postdissection aneurysms is a safe procedure in patients deemed unfit for open surgery. Our experience suggests that close follow-up is mandatory as secondary procedures are frequently required to completely exclude the false lumen.

Dates et versions

hal-04467683 , version 1 (20-02-2024)

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Citer

Rafaelle Spear, Adrien Hertault, Katrien van Calster, Nicla Settembre, Matthieu Delloye, et al.. Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms. Journal of Vascular Surgery, 2018, Journal of Vascular Surgery, 67, pp.685-692. ⟨10.1016/j.jvs.2017.09.010⟩. ⟨hal-04467683⟩
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